Orthodontic appliance and method



Feb. 25, 1964 Filed Aug. 30, 1962 S. ASHER ORTHODONTIC APPLIANCE ANDMETHOD 2 Sheets-Sheet 1 INVENTOR. .Szdney Asher BY 3; MY M4 4 4) aziysFeb. 25, 1964 s. ASHER ORTHODONTIC APPLIANCE AND METHOD 2 Sheets-Sheet 2Filed Aug. so. 1962 INVENTOR. Sidney Asher BY .9 W

CZii'l/s United States Patent 3,121,953 ORTHODONTIC APPLIANCE AND METHODSidney Asher, Chicago, Ill., assignor to Pages, Inc., Chicago, 111., acorporation of Illinois Filed Aug. 30, 1962, Ser. No. 220,519 Claims.(Cl. 3214) This invention relates to novel and improved methods andmeans for correcting certain classes of malocclusion and for realigningone or more teeth at the beginning, during, or at the conclusion oforthodontic treatment.

Orthodontic arches, colloquially known as braces, have been applied topatients teeth for many years for correcting a variety of conditions. Bymaking adjustments in selected parts of those arches and by usingvarious types of supplemental tools and appliances in conjunction withthose arches, dentists and orthodontists have been able to elfectchanges in patients mouths when changes are necessary from a functionalviewpoint or desirable from a cosmetic point of view.

The face-bow is one of the types of supplemental tools which is used. Aface-bow can be described generally as an orthodontic appliance whichmay be adjusted periodically by an orthodontist and which is readily andeasily attachable to an orthodontic arch by the patient himself. Itextends outwardly of the patients mouth and is activated by externalmeans such as head harnesses or neck straps.

This invention contemplates the use of a face-bow of novel constructionfor correcting certain classes of malocclusion by methods and meanswhich are more effective and more rapid than procedures and applianceswhich are now available. Particularly does it enable orthodonticpractitioiners to avoid the use of palates or plates and to use insteadfar simpler improve face-bows.

The novel face-bow of this invention may be used to correct malocclusionin both extraction and non-extraction cases, and in a variety of classesof such cases.

One of the techniques with which this invention is concerned is that ofsectional arch treatment. It is possibie, with the face-bow to bedescribed, to move a canine and an entire buccal segment as a unitdistally in the alveolar trough when such treatment is desirable,without the necessity of using separate finishing appliances and withoutthe necessity of extracting teeth as is ofttimes done to provide spaceinto which the canines may be posteriorly relocated.

Movement distally of one or both entire buccal segments very often maybe necessary before locked in and severely malposed (crushed) upperincisors can be aligned correctly and permanently. Unless sufficientroom is obtained for these crushed incisors they will tend to relapse.Where necessary, movement distally of one or both buccal segmentsincluding the canines to make full room for the incisors assures apermanent alignment of the upper incisors. In such cases which haverequired correction of locked in and crushed incisors with forwardlydisposed canines and buccal segments, extraction of the first bicuspidsto facilitate realignment of the incisors and canines is frequentlyundertaken. Since the buccal segment and canine can be easily andrapidly moved posteriorly as a unit in accordance wtih this invention,that enables the orthodontist to align or distally drive the incisorsmuch more quickly. That results in faster, less expensive correction andcircumvents the necessity, in many cases, of extracting bicuspids.

Thus the technique of moving an entire buccal segment and canine as aunit may be used where that is the only correction necessary and alsowhere it is desirable to align the incisors.

When face-bows without the improvements of this in- 3,121,953 PatentedFeb.25, 1964 "ice vention are used, because strong, vigorous forces areexerted against the first molars through the face-bows, spaces sometimesopen up at the contact points of the first molar and second bicuspid,the second bicuspid and the first bicuspid, and the first bicuspid andthe canine. That can and does occasionally occur, particularly whendistal driving of the upper buccal segments is the principal functionbeing performed by the face-bows, and the buccal segments are in forwardposition with crushed incisors and high canines, that is caninesdisposed in part diagonally across the front of the adjacent lateralincisors. With the face-bow to be described, since the entire buccalsegment can be relocated as a unit, such spaces can be prevented fromopening up. And, where spaces have already opened up at those contactpoints, the face-bow of this invention may be used to close those spacesrapidly and easily.

It is also possible, with the face-bow of this invention, to distallydrive the upper anterior teeth to correct cases of overjet or buck teethand even move the entire buccal segment and close spaces in that segmentwhile the upper anterior teeth are being distally driven.

It is therefore the principal object of this invention to provide noveland improved means for correcting certain classes of malocclusion.

It is a further object of this invention to provide a novel face-bowembodying improved means for correcting certain classes of malocclusion.

Yet another object of this invention is the provision of a face-bowwhich is capable of performing several corrective techniquessimultaneously whereby a more rapid ultimate occlusion may be achieved.

Yet another object of this invention is the provision of a correctiveappliance that obviates the necessity of extracting teeth in many caseswhere extraction has been otherwise necessary to achieve desiredorthodontic results.

Further within the purview of this invention is the provision of novelmethods for moving canines and entire adjacent buccal segments as units.

Further objects and advantages will become apparent to those skilled inthe orthodontic arts from the following description and drawings ofwhich:

FIG. 1 is a plan view of a preferred embodiment of the face-bow of thisinvention;

FIG. 2 is an enlarged partial side elevation taken substantially alongline 22 of FIG. 1;

FIG. 3 is an enlarged partial perspective view of a portion of theface-bow of FIG. 1 looking downwardly on and from the right of FIG. 1;

FIG. 4 illustrates a case of malocclusion wherein the face-bow of FIG. 1has been fitted to move the canine and an entire buccal segmentposteriorly as a unit; and

FIG. 5 is an enlarged perspective view (taken from upper right of themouth) showing the face-bow of FIG. 1 in the vicinity of the retractingwire.

The face-bow 1 illustrated in FIGS. 1 to 3 includes a frame 10. Frame 10comprises diverging rearwardly extending arms, a long arm 12 and a shortarm 14, each terminating at one end in a hook 16. The other ends of thearms 12 and 14 meet generally U-shaped segments 18 which in turn arejoined by an elongated central portion 20.

An arch engaging member 22 is welded adjacent its central segment 24 tocentral portion 20. To assist in connecting central segment 24 andcentral portion 20 to each other, and to reinforce the central area,silver solder 26 is provided. Lever arms 28 diverge and extendrearwardly from central segment 24. They may be joined by centralsegment 24, as described, or may be individual arms connected adjacentcentral portion 20.

For a purpose to be described, each lever arm 28 is provided with adouble bend section 30 and terminates in slightly offset ends 32.

Hooks 34 are brazed to lever arms 28 at positions which, when theface-bow is inserted in a patients mouth, will lie in the vicinity ofthe point of contact of the canine and second bicuspids. Hooks 34 openrearwardly.

Spaced rearwardly of right-hand hook 34 is retracting Wire 36.Retracting wire 36 is brazed to lever arm 28 with silver solder. Wire 36includes an inverted hairpin or U-shaped section 38, the rounded end ofwhich section is disposed so that it will lie within the vestibule ofthe mouth. Hairpin section 38 terminates in a forwardly extendingretracting wire arm 40 which lies inside of hook 34. At the forward endof retracting wire arm 40, an activating section 42 is disposed.

In the embodiment illustrated the activating section 42 is generallysemi-circular in shape and is adapted to surround partially the tooth tobe directly acted upon or against by the retracting wire 36. Tofacilitate engagement with the teeth, as will be described, the end ofthe activating section is somewhat thinned down. However, the preciseconfiguration and disposition of activating section 42 will depend inlarge measure upon'the initial position of the tooth it acts upon, thedirection in which, and the extent to which, the tooth is to be moved,the particular corrective technique which is indicated, and otherfactors which will be apparent from this description to those skilled inthe orthodontic arts.

For example, if it is desirable merely to move the canines rearwardly toassist in closing spaces between the posterior teeth, then theactivating section 42 may be disposed adjacent the gum line. If,however, it is necessary or desirable to rotate a canine which haserupted diagonally across a lateral incisor, then the activating sectionmay encompass a lower aspect of the mesial surface of the canine to givegreater leverage.

It is, however, the retracting that contributes to the novelty andimproved results obtained with the face-bow of this invention.

As will become apparent, hooks 34 are provided to anchor rubber bandsfor exerting distal driving forces against the incisors. However, theyare adapted and are disposed to perform an additional function as well.

Since retracting Wire arm 40 is relatively long, the activating section42, as well as wire arm 40, may tend to ride up vertically on the toothit contacts. Hooks 34 are used to assist in limiting and fixing thevertical disposition of activating section 42. Hook 34, as illustrated,substantially prevents upward vertical movement of retracting wire 36,at the same time permitting horizontal movement of retracting wire 36 asthe spring action thereof drives the canines rearwardly.

Although the specific dimensions are not critical, it bears mentioningthat a face-bow of this invention can be constructed of 304 stainlesssteel wire, having a frame of 0.066" in diameter, lever arms 28 of0.050" in diameter, turned down to 0.045 in diameter rearwardly of thepoint at which retracting wire 36 is connected, :1 retracting Wire 0.032in diameter and a flattened end portion, the end of section 42, 0.020"in width.

T o understand fully the manner in which the embodiment of the face-bowof this invention which has been described is to be utilized, itsoperative relationship to an orthodontic arch will be described withreference to FIGS. 4 and 5.

FIG. 4 incorporates an orthodontic arch 50. Orthodontic arch 50 consistsgenerally of a plurality of caps 52 suitably secured to a plurality ofteeth in any conven tional manner, and an orthodontic arch wire 54connected to caps 52 by brackets 56. Brackets 56 have upper and lowersections between which the arch wire is adapted to lie. To retain archwire 54 in its nestled position between the upper and lower segments ofthe brackets, tie wires 58 are provided. Nothing unusual in theorthodontic arch is necessary to the practice of this invention exceptthat it must be an orthodontic arch capable of cooperating with theface-bow of this invention.

Two molar caps bear molar tubes 60. Each molar tube 69 is provided withtwo longitudinal tunnels, a lower tunnel 62 and an upper tunnel 64. Itis through lower tunnel 62 that each end of arch wire 54 extends, eachend terminating in rearwardly disposed angled segments 66. Forwardly oftunnels 62, loops 68 are provided in arch wire 54. Loops 68 function tostop arch wire 54- from moving rearwardly more than a predeterminedamount, and angled segments 66 resist withdrawal of the arch wire fromlower tunnels 62.

Upper tunnels 64 are adapted to receive the offset lever arm ends 32.lever arm ends 32 extend into tunnels 64 as far as the double bendsections 30. Double bend sections 3% limit, where desirable ornecessary, the extent to which ends 32 may move inwardly of uppertunnels 64 and are provided for that limiting function.

To maintain the face-bow in operative engagement with the orthodonticarch, an elastic neck strap 70 having hooks 72 adapted to engage framearm hooks 16 is provided. The degree of tension it is desired to exertagainst the molar tubes 60 of orthodontic arch 5t) dictates the strengthof neck strap 70. To vary the tension, neck straps of different lengthsmay be used. Adjustments in tension may be made from time to time.Alternatively an adjustable neck strap may be provided. The relativelengths of long arm 12 and short arm 14 also assist in controllingrelative magnitude of the forces exerted against the molar tubes by thedouble bend sections 30. The double bend section adjacent long arm 12exerts greater force against its molar tube 60 than does the double bendsection adjacent short arm 14.

So that the elastic strap 70 is free-flowing, that is enabled to seekits position of equilibrium freely, and thereby exerts the properpredetermined forces against the rearwardly extending arms of theface-bow, a satin sleeve 74 may be provided. The inner surface of thissleeve rests against the patients neck thereby enabling elastic strap 70to move more freely with respect to the back of the neck than wouldotherwise be possible.

To complete the full assembly illustrated in FIG. 4, reference should bemade to rubber band 76. Rubber band 76, generally twisted several times,extends between hooks 34, beneath the brackets 56 on the lateral andcentral incisor caps. The rubber band induces distal driving of theincisors in a known manner.

FIG. 4 illustrates a condition wherein it is desirable to move theentire buccal segment and the canine, the whole posterior section,rearwardly as a unit. The face-bow illustrated in FIGS. 1 to 3 has beenshown in FIG. 4 in operative relationship to the orthodontic arch toaccomplish that purpose.

It is apparent from FIG. 4 that before the incisors can besatisfactorily relocated, it is necessary to drive the caninerearwardly. Unless the buccal segment is also driven rearwardly in thealveolar trough to provide space for the canine, the first or secondbicuspid would have to be removed, as is the case in present orthodonticpractice.

A face-bow of this invention is disposed to exert driving forces againstthe first molar and the canine to drive the whole section rearwardly asa unit. Once the canine and the buccal segment are relocated, theincisors may be brought into proper occlusion and aligned correctly andpermanently. One of the great reasons for failure of orthodontic resultsis that the incisors are aligned without regard to obtaining permanentarch length.

It is possible, if some distal driving of the incisors is necessary, tobegin that operation after the buccal segment and canine treatment hasbegun. It is not necessary to complete relocation of the posterior teethbefore distal driving of the upper anterior teeth ensues, as ispresently the case where palates are used to relocate canines as aseparate initial technique. Neither is it necessary to extract teeth toprovide room for a canine as is the present practice.

Face-bow 1 is shown in FIG. 4 as being connected to the orthodontic arch50. In fitting the face-bow to the orthodontic arch a number ofadjustments must be made, including placing double bend sections 30 inlever arms 28 to determine and fix the orientation of the other parts ofthe face-bow with respect to the teeth.

Additionally frame arms 12 and 14 should be molded to the particularpatients face and U-shaped segments 18 and the frame as a whole moldedto accommodate the specific shape and size of the patients mouth, teethand lips, all in a manner known to the art.

Then retracting wire 36 must be adjusted to the size and disposition ofthe particular teeth to be acted upon. To shorten or lengthen theeffective length of forwardly extending 'wire arm 40, the width ofhairpin section 38 may be adjusted such as by squeezing it with apliers. Hairpin section 38 also acts as a spring to help activateretracting Wire 36. Then activating section 42 is finally conformed tothe particular patient, such as by molding the semi-circular section 42seen in FIGS. 1 to 3 to engage the mesial portion of the canine near thegum line.

Hooks 34 also serve to mount rubber band 76 which distally drives theincisors. So, as the canines are drawn rearwardly by the retracting wire36, the incisors may be driven distally. However distal driving need notaccompany treatment with the retracting wire.

Whether or not hooks 34 are used to accomplish distal driving, they maybe utilized to orient retracting Wire 36 and to prevent it from rid-ingup on the canine. In the absence of hook 34, other equivalent means maybe provided to assist in orienting retracting wire 36.

In installing the face-bow described, it having been satisfactorilyadjusted, it is necessary to be certain that both offset lever arm end32 and activating section 42 assume their proper positions. Dependingupon the final ad justed configuration, it may be easier to insert armends 32 in the tunnels 64 first, and then spring activating section 42into place. Alternatively, it may be easier to insert both at the sametime. The order is not critical, as long as the desired action isobtained from retracting wire 36.

It is apparent that spring action is transmitted to the canine throughthe retracting wire 36. Some of that is derived through a properlyadjusted hairpin section 38 and part of it comes from the dispositionand orientation of arm 4% and activating section 42. Part of the drivingforce for the canine is furnished by lever arm 28 as it moves rearwardlyduring treatment.

In the sectional arch treatment described, forces up to several ouncesmay be exerted against the canines through the retracting wire 36.Forces in terms of pounds may be transmitted to the first molar throughthe molar tubes from the neck strap if necessary. The magnitudes ofthose forces will depend largely upon the individual patient and must bearrived at empirically.

As was mentioned earlier, other corrective techniques may be employedwith the face-bow of this invention. For example, in a non-extractioncase where spaces have developed at the contact points between thecanines and first bicuspids, the first bicuspids and the secondbicuspids, etc., the retracting wire may be used to drive the caninesrearwardly along the alveolar trough to close up those spaces. In such acase the activating section of the arch Wire may be located just abovethe contact point between the canine and lateral incisor gingivally, andthe activating section may be generally straight and at right angles to,and in a generally horizontal plane with respect to, the forwardlyextending wire arm 40. Hooks 34, or the like, may be used to assist inmaintaining the desired disposition of auxiliary spring wire 36, forexample to prevent the activating section from cutting the gum if thatbe necessary.

A unilateral right-handed face-bow embodying the invention herein hasbeen illustrated. It is apparent that a left-handed face-bow may beconstructed in a manner identical to that described for treating theleft side of the upper jaw. In such a case the left arm of the framewould be the longer, and the right arm, the shorter, of the two arms.

It is also possible to construct a face-bow in accordance with thisinvention which provides a retracting wire on each side, for examplewhere rearward driving of both upper canines and upper buccal segmentsis desired.

The face-bow described herein and the methods and techniques describedherein will make apparent to those ordinarily skilled in the art otheradvantages of this invention, and other techniques which may be employedwith this invention. The foregoing description, likewise, will makeobvious to others skilled in the orthodontic arts the fact that variouschanges may be made in the embodiments illustrated and discussed withoutdeparting from the spirit and scope of the invention as claimed.

I claim:

1. A face-bow including a frame having two diverging arms extendingdistally when the face-bow is worn, each of said arms terminating at itsdistal end in a hook, two diverging distally extending levers disposedbetween said arms and adapted to engage an orthodontic arch, means forlimiting distal movement of said levers with respect to portions of anorthodontic arch which said levers are adapted to engage, and aretracting wire connected to at least one of said levers and adapted toengage a tooth when said levers are in engagement with an orthodonticarch.

2. The face-bow of claim 1 wherein said retracting wire has an elongatedsection lying generally parallel to the lever to which it is connected,and means connected to the same lever adjacent said elongated sectionand overlying said elongated section for restricting freedom of upwardmovement of said elongated section.

3. The face-bow of claim 1 wherein said arm closer to the lever bearingthe retracting wire is longer than said other arm.

4. A face-bow having a frame including two diverging arms extendingdistally when said face-bow is worn, hooks integral with the distal endsof said arms, a rigid central portion, and two diverging distallyextending levers connected adjacent said central portion and lyingbetween said arms and adapted to engage and cooperate with anorthodontic arch, said face-bow further including means integral withsaid levers for limiting their distal movement when in engagement withsaid orthodontic arch,

and a retracting wire connected to one of said levers for engaging atooth.

5. The face-bow of claim 4 wherein said retracting wire includes amesially extending elongated portion lying closely adjacent the lever towhich it is connected, an inverted U-shaped segment at the distal end ofsaid mesially extending elongated portion and a laterally extendingactivating section connected to the mesial end of said elongatedportion, and restricting means connected to the lever bearing theretracting wire, said restricting means comprising a distally extendinghook overlying said elongated portion for restricting freedom of upwardmovement of said elongated portion, and a complementary second distallyextending hook connected to the other of said levers, said hooks beingadapted to support a rubber band for distally driving a patientsincisors.

6. A face-bow comprising a frame having two diverging arms extendingdistally when the face-bow is worn and terminating at their distal endsin hooks, and a reinforced central portion, two diverging distallyextending levers adapted to engage an orthodontic arch connectedadjacent said central portion and lying between said arms, meansintegral with said levers for limiting their distal movement when inengagement with an orthodontic arch, a mesially extending retractingwire connected to the first of said levers, said retracting wireincluding an inverted U-shaped section, an elongated section and anactivating section at the mesial end of said elongated section extendinglaterally and inwardly of said elongated section, a first hook connectedto said first lever overlying said elongated section for restrictingupward movement of said elongated section, and a second hook on thesecond lever complementary to the first hook.

7. An orthodontic appliance for distally moving a canine and adjacentbuccal segment as a unit comprising an orthodontic arch having molartubes, a face-bow having strap engaging hooks and having portions seatedin the molar tubes and means limiting the extent to which said portionsmay move distally, a neck strap connected to said face-bow strapengaging hooks, a mesially extending activatable retracting wireconnected to said face-bow and adapted to engage said canine, wherebywhen said face-bow is activated by said neck strap and said retractingwire is in activated engagement with said canine, the entire canine andbuccal segment section is moved distally as a unit.

8. A method of relocating a buccal segment and adjacent canine as a unitin a patient wearing an orthodontic arch having molar tubes comprising,inserting the ends of lever arms of a face-bow into the molar tubes,engaging the canine with an activated retracting wire connected to theface-bow, activating the face-bow with a neck strap to exert forcesagainst the molars in a distal direction whereby over an extended periodof time the entire canine and buccal segment section is driven distally.

9. A method of correcting malocclusion wherein relocation of a buccalsegment and adjacent canine section is necessary and wherein distaldriving of the incisors is necessary and cannot be accomplished untilthe section is relocated, comprising fitting a patient with anorthodontic arch having molar tubes and incisor caps, inserting theterminal portions of levers of a face-bow into the molar tubes, engagingthe canine with an activatable retracting wire connected to theface-bow, activating the face-bow with a neck strap to exert forcesagainst the molars and against the canine, continuing exertion of forcesagainst the molars and canine until partial relocation of the buccalsegment and canine section is accomplished, then, while continuing that,distally driving the incisors by connecting a rubber band spanning theincisors to the face-bow, and continuing those treatments untilmalocclusion is corrected.

10. A method of correcting malocclusion in a patient wearing anorthodontic arch comprising, engaging the orthodontic arch with aface-bow, engaging at least one tooth with a retracting wire connectedto the face-bow, and activating the retracting Wire whereby over anextended period of time the retracting wire moves the tooth into moreproper occlusion.

OTHER REFERENCES Orthodontia, by Victor H. Jackson, published in 1904(pages 399-403 relied on).

1. A FACE-BOW INCLUDING A FRAME HAVING TWO DIVERGING ARMS EXTENDINGDISTALLY WHEN THE FACE-BOW IS WORN, EACH OF SAID ARMS TERMINATING AT ITSDISTAL END IN A HOOK, TWO DIVERGING DISTALLY EXTENDING LEVERS DISPOSEDBETWEEN SAID ARMS AND ADAPTED TO ENGAGE AN ORTHODONTIC ARCH, MEANS FORLIMITING DISTAL MOVEMENT OF SAID LEVERS WITH RESPECT TO PORTIONS OF ANORTHODONTIC ARCH WHICH SAID LEVERS ARE ADAPTED TO ENGAGE, AND ARETRACTING WIRE CONNECTED TO